The effect of angiotensin-converting enzyme inhibitors on the rate of ascending aorta dilation in patients with bicuspid aortic valve.

BACKGROUND: Bicuspid aortic valve (BAV), the most common congenital heart defect, is associated with progressive aortic dilation and increased risk of dissection and rupture. The use of an angiotensin-converting enzyme (ACE) inhibitor has recently proven effective in slowing the rate of aortic dilation in other aortopathies, suggesting it may also be useful in managing BAV. We sought to determine whether ACE inhibitors effectively reduce the rate of aortic dilation in adolescents and young adults with BAV.

METHODS: A retrospective cohort study was undertaken. Subjects receiving ACE inhibitor therapy were compared with controls with BAV and matched for the degree of aortic regurgitation. The rate of change in ascending aorta diameter was compared between the two groups.

RESULTS: Among the 141 subjects identified in the patient records, 103 were receiving no medication and 38 were taking ACE inhibitors. Over a mean follow-up of 37 months, the ascending aorta Z-score increased slightly among those receiving ACE inhibitor +4.5 ± 1.6 to +4.7 ± 1.6. The rate of change was no different than those subjects not receiving ACE inhibitors, P = .64.

CONCLUSION: In an adolescent and young adult population with an isolated BAV, there is no proven benefit to ACE inhibitor use with regard to slowing rate of ascending aortic dilation.